Binational Health Week Mobilizing Netwroks · and 10% of the non-Latino population (Santibañez,...

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BHW Article Page 1 8/12/2006 Binational Health Week: Mobilizing Existing Networks and Resources to Focus on Migrant Health Care Issues Xóchitl Castañeda, MA Karyn Ott Smith, MA Rosario Alberro, MA Mario Gutiérrez, MPH Xóchitl Castañeda, Director California-Mexico Health Initiative CPRC, University of California Office of the President 1950 Addison Street, Suite 203 Berkeley, CA 94720-7410

Transcript of Binational Health Week Mobilizing Netwroks · and 10% of the non-Latino population (Santibañez,...

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Binational Health Week:

Mobilizing Existing Networks and Resources to Focus on

Migrant Health Care Issues

Xóchitl Castañeda, MA Karyn Ott Smith, MA Rosario Alberro, MA

Mario Gutiérrez, MPH

Xóchitl Castañeda, Director California-Mexico Health Initiative

CPRC, University of California Office of the President 1950 Addison Street, Suite 203

Berkeley, CA 94720-7410

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ABSTRACT The California-Mexico Health Initiative, a program of the California Policy Research

Center, University of California Office of the President, endorsed by the Mexican

government and funded primarily by The California Endowment, has been the sponsor of

a highly focused annual effort that seeks to reduce health disparities and improve access

to care for the low income population of Mexican origin in the U.S. as well as in their

places of origin. This innovative strategy, called Binational Health Week (BHW), seeks to

mobilize existing networks and resources in a highly-organized, synergistic effort that

result in significant and concrete improvements that do not require major infrastructural

changes. The strength of BHW — as well as its weakness — is that it relies on volunteer

contributions of more than 300 organizations that all come together once a year to

provide services to this highly underserved population. During BHW this year, these

organizations provided services to over 70,000 people throughout 22 counties of

California and 8 states of Mexico with high migration rates.

Keywords: community health; binational programs; migrants; immigrants; Mexicans;

program planning; networks

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INTRODUCTION TO BINATIONAL HEALTH WEEK

Since its inception in October 2001, Binational Health Week (BHW) has been

instrumental in developing programs aimed at improving the health and well-being of

migrant workers and their families.1 Although the California-Mexico Health Initiative

(CMHI) focuses on the health needs of Mexican-origin and other Latino migrants and

their families (including permanent and temporary residents in both rural and urban

areas), this week-long event benefits underserved Latinos2 regardless of their national

origin.

BHW’s concept was built upon Mexico’s highly successful immunization crusades.

Since 1993, the Mexican Ministry of Health (SSA) has implemented three nationwide

health weeks a year designed to improve the health of underserved populations through

festive social mobilization.3 A large part of BHW’s success is due to the CMHI’s

reliance on existing partnerships and networks including clinics, county based

organizations, university resources, Mexican home town associations, and the

involvement of Mexico’s Ministry of Health and Foreign Affairs. Binational Health

Week has been a catalyst in facilitating dialogue among Mexican-origin migrants and

immigrants, Latino legislators, philanthropic organizations, Mexican and California

government officials, Mexican-Americans, and Chicanos.

1 Using Rouse’s formulation, the term “migrants” rather than “immigrants” will be used throughout this article. The term immigrants suggests an unidirectional movement, which does not portray the reality of millions of Latinos going back and forth between their countries of origin and the United States, as well as between geographical locations within the United States. Instead the term migrant implies a continuum in the migration process of individuals who spend varying amounts of time in multiple communities across borders, often following seasonal growing patterns and economic cycles (Rouse, 1995). 2 “Latinos” is a political term used to designate a heterogeneous Caribbean and Latin American population sharing a historical background and cultural perspectives (Clayson, Casteñada, Sanchez, and Brindis, 1999-2000). 3 SSA uses 59,000 temporary stations across Mexico to provide health services during these weeks.

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Using the terminology of network theorists, CMHI is fulfilling the role of a network

weaver, first creating new interactions between groups and then helping these groups

work together and eventually begin weaving their own networks. In “Building

Sustainable Communities through Network Building,” Valdis Krebs and June Holley

describe the two parts of network weaving:

One is relationship building, particularly across traditional divides, so that people

have access to innovation and important information. The second is learning how

to facilitate collaborations for mutual benefit…. This culture of collaboration

creates a state of emergence, where the outcome—a health community—is more

than the sum of the many collaborations. The local interactions create a global

outcome that no one could accomplish alone (Krebs & Holley, 2002).

Through BHW, CMHI not only enables connections to form between different groups

interested in migrants and/or health issues, but it also provides them with a collaborative

project that shows the effectiveness of working together to improve the health of

migrants. In addition, CMHI demonstrates how the communication technologies

available today can empower these networks through the development of databases and

on-line directories, increasing the depth and reach of these networks’ efforts.

CMHI has identified six priority health topics for BHW, based on disease incidence

levels among the Latino population4 in California, data available from Mexico, and input

from CMHI’s advisory board. These are:

4 Note: In California, disease incidence and prevalence data are generally available for the Latino/Hispanic population rather than specifically categorized by country of origin.

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• mental health, including issues related to domestic violence, alcohol, and

substance abuse

• nutrition, including the relationship between diet and diabetes, hypertension, high

cholesterol, and obesity

• infectious diseases, including HIV/AIDS, tuberculosis, hepatitis, and STDs

• occupational health and injury prevention, especially issues relevant to adolescent

agricultural workers

• women’s health, including issues related to cervical and breast cancer, gender

issues, and reproductive health

• oral health, especially dental care and prevention of tooth decay.

To address these specific health needs within the migrant population, CMHI organizes

BHW around three main components:

1. Health service provision and health promotion activities conducted in both

countries, which include: health information and screening fairs; workshops and

other cultural approaches to health promotion (e.g. theater presentations, radio

soap operas, interviews, public service announcements, television programs, and

newspaper articles); distribution of health education materials such as posters,

brochures, and videos; and outreach activities to enroll eligible population on

existing health insurance programs such as Medi-Cal and Healthy Families.

2. Binational Policy Forum on Migrant and Immigrant Health Issues to convene

legislative representatives (including the leadership, committee chairs, and

members of all key health committees); university officials; members of county

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boards of supervisors; union leaders; heads of major media organizations; state

agencies directors; community health center leaders, and other key stakeholders

from both countries — to discuss the challenges and unique opportunities of

working collaboratively to improve the health and well-being of people crossing

the Mexico-U.S. border. Officials are targeted from selected Mexican States,

including Baja California, Guanajuato, Guerrero, Jalisco, Michoacán, Morelos,

Oaxaca, Puebla, and Zacatecas.

3. Press events to open and close BHW events, including a press conference during

the Binational Policy Forum on Migrant and Immigrant Health Issues with high-

level government officials from Mexico and the United States, University of

California representatives, foundation directors, legislators, and community

leaders. A comprehensive press strategy also covers the main local events in

each of the counties and airs media messages culturally and linguistically

appropriate, to increase awareness of illness and disease among target

communities.

BACKGROUND ON THE CALIFORNIA-MEXICO HEALTH

INITIATIVE

CMHI was created in January 2001 under the auspices of the California Policy Research

Center to facilitate the development of complementary and coordinated projects

involving key stakeholders in Mexico and the United States. A binational advisory board

ensures that the efforts of CMHI are bilateral, synchronized, and complementary.

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The overarching vision of CMHI is to realize a future of health across borders for the

Mexican-origin population in the United States through binational strategies and

cooperation. To attain this vision, CMHI’s mission is to coordinate resources in the

United States and complement resources in Mexico to increase access to and use of

health services, expand health insurance coverage, improve health outcomes, reduce

health disparities, enhance the cultural competency of health care personnel, and

implement innovative strategies to address unmet health needs of the Mexican-origin

population living and working in the United States.

Through funding from the University of California, The California Endowment (TCE),

and the California HealthCare Foundation, CMHI has completed three successful years of

operation. Working collaboratively with other organizations, CMHI has launched eleven

programs in addition to BHW, including: creation of health stations (ventanillas de salud)

within Mexican consulates; development of a binational epidemiological surveillance

system pilot project; release of a special call for research proposals on migration and

health; development of a database and on-line directory on migrant health services and

programs; creation of a clearinghouse of health education materials in both Spanish and

English; and coordination of training for health care professionals and medical students.

While CMHI’s initial activities have focused on California, the strategies described here

could be replicated in other states with migrant populations.

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BACKGROUND ON MIGRANT HEALTH

It is important to recognize that the Mexicans who choose to migrate to the U.S. in search

of work come with a certain health capital. In other words, there is some degree of

natural self-selection in terms of physical health. If undocumented, they must be

particularly strong and healthy enough to cross the border and then to engage in the

heavy manual labor often offered to them. Most migrants come fully immunized and

having grown up on a diet based on more fruits, vegetables and grains than many in the

U.S. However, once here, their health capital deteriorates severely in just a few years.

They are disproportionately represented in dangerous industries (construction,

manufacturing, and agriculture) and in hazardous occupations within those industries

(Labor Occupational Health Program, UCB, 2002.) Certain factors also increase the risk

of these occupations for migrant workers, such as a decreased likelihood in reporting

hazards on the job due to fear about job security, legal status, language issues or lack of

knowledge about their rights (Labor Occupational Health Program, UCB, 2002.)

Furthermore, the low pay of these occupations means that over 25% of people of

Mexican origin live in poverty here in the U.S., as compared with 20% of Latinos overall

and 10% of the non-Latino population (Santibañez, 2003). This level of poverty

manifests itself in poor diet, inadequate living conditions, and increased vulnerability to

short-term and chronic sickness.

Their Economic Role

Both the U.S. and Mexican economy depend on the labor of migrant workers in the U.S.

Undocumented workers alone generate goods and services worth more than $120 billion

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a year in the U.S. (Martin, 1996). In Mexico one out of every 20 households benefit from

the remittances, which tend to concentrate in communities with less than 2,500

inhabitants (CONAPO). And, during the 1990s Mexican immigrants sent home some

$33 billion in remittances (CONAPO, 2000). In 2003 alone, the total of remittances was

$14.5 billion, becoming the highest single source of income for Mexico (Orozco, 2003).

As we all know, migrant farm labor is the foundation of the multi-billion dollar U.S.

agricultural industry (National Center for Farmworker Health, 2002). Of all California’s

fieldworkers, 95% are immigrants. Ninety-one percent were born in Mexico. And many

of the remaining 5% are children of Mexican parents (California Institute for Rural

Studies, 2001). In other industries, Latinos account for 25.1% of textile workers, 20.5%

of cleaning and building service workers (U.S. Department of Labor, 1998) and 15% of

all construction workers (National Safety Council, 2002). The U.S economy is

dependent on the healthy bodies of migrant workers to do the manual labor still required

in our industrial society. However, the market place does not factor in the cost to these

bodies, but prefers to consider them a resource that can be depleted then disposed of

when no longer of use. In reality, the “fragmented” bodies of migrant workers are

subsidizing the actual cost of our food, clothing, and shelters. It is therefore our

responsibility to educate ourselves about the true state of health (physical and mental) of

migrant workers and to work to preserve their health, not only because they are a

valuable resource but because they are human beings deserving our respect. As

Almudena Ortíz has said, “We must put a face on the hands that labor [for] the food we

eat.” And clearly any attention to migrant well-being has to be understood as a bilateral

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responsibility because of this population’s dual economic and social impact on both

countries.

The Hazards to Their Health

The hazardous occupations of migrant workers, combined with generally low wages and

little access to health services, have resulted in a much higher incidence rate for many

serious injuries and illness in migrant workers than in the general population. Latinos

have a 14% fatality rate in the workplace, yet make up only 11% of the workforce (U.S.

Department of Labor, 2002). Cardiovascular disease is the leading cause of death among

Latinos in California and nationwide, as well as among the Mexican-origin population

(National Vital Statistics Report, 2000). Musculoskeletal conditions are the most

commonly reported health problem among the nation’s 2.5 million agricultural workers,

who are faced with numerous ergonomic hazards in fields, nurseries, orchards and

packing sheds (Davis, 2000). And the prevalence of diabetes in Mexican Americans is

1.8 times higher than in non-Latino whites (Harris, Flegal, Cowie, Eberhardt, Goldstein,

Little, Wiedmeyer and Byrd-Holt, 1988-1994). The Latino population makes up 12% of

the total population of the U.S. but 15% of the population aged 10-19, the majority of

them of Mexican origin. The teen birth rate for Latinos is nearly four times the birth rate

for non-Latino white teens in California (California Department of Health Services,

1995). While the infant mortality rate among migrants is 25% higher than the national

average (National Center for Farmworker Health, 2002).

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The Scope of the Challenge

Clearly migrants and their families deserve and are in desperate need of improved health

care access and effective health insurance coverage in order to preserve their health.

However, the scope and complexity of realizing this, especially in these economic and

political times, seems daunting. The sheer size of this population presents a challenge.

In the United States there are 39 million Latinos, of which 67% or 22.5 million are of

Mexican origin (U.S. Census 2002). In California alone, there are 11 million Latinos, of

which 8.5 million are of Mexican origin, comprising 25% of the state’s total population

(U.S. Census 2002). Compounding the difficulty, a large percentage of this population

does not have health insurance — the surest access to affordable health care. In

California, almost 1/3 of Latino children and 41% of non-elderly adult Latinos are

uninsured — the majority of Mexican origin. There are 2.25 million uninsured Latino

adults in California, roughly twice as many as any other group (UCLA Center for Health

Policy Research, 2001). In California, only 43% of Latinos have job-based insurance,

compared to 71% of non-Latino whites (Brown, Niñez and Rice, 2001).

The Obstacles to Health

The disparities are further exacerbated by the tremendous number of obstacles facing

migrants of Mexican origin who need access to health services for themselves and their

families. Because of language and education barriers as well as misinformation, many

Mexican migrants are not even aware of programs for which they might be eligible.

Many migrants do not seek health care benefits through state or county health care

programs for fear of jeopardizing their ability to obtain legal residency, endangering their

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current Green Card, preventing them from sponsoring a family member, or hurting their

sponsor. Some are undocumented and are, therefore, ineligible for many programs.5

Even when documented, many migrants work in occupations that do not tend to provide

health insurance, like agriculture. In the U.S. 70% of the agricultural-worker population

does not have health insurance (National Center for Farmworker Health, 1999) and one

out of every three Mexican immigrants in California is in a farmworker household

(Gabbard). In a representative sample survey of agricultural workers, only 7% were

enrolled in any government program serving low-income people (The California

Endowment, 2001).

The Mexican migrant also faces cultural differences when seeking health services in the

U.S. They have less of an awareness of preventive care and tend to only seek health

services when they are really sick. Only 1.4% of all visits to migrant health clinics are

for general medical exams, 39% below the U.S. average (National Center for

Farmworker Health, 2002). Gender also plays a major role in a migrant’s health. In

Mexico, women tend to be the gatekeepers of health, recommending where to go for

treatment and how follow up care is administered. In the case of agricultural workers in

California, 82% are male, half of them come unaccompanied and the majority has

families in Mexico (California Institute for Rural Studies, 2001). In practice, this means

many male migrant workers simply do not seek medical attention. In a representative-

sample survey in California, nearly 32% of male agricultural workers said that they have

had never been to a doctor’s office or a clinic in their lives, while only 48% had been to a

5An estimated 4.5 million unauthorized Mexicans live in the U.S. (Bean, Van Hook, and Woodrow-Lafield, 2001).

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doctor or clinic at least once during the previous two years (The California Endowment,

2001).

THE STRATEGY

The abundant health care needs of this population appear to be almost in inverse

proportion to the scarce resources currently allocated to addressing migrant health issues.

And the cost of building an effective health care system to improve the health of migrant

workers and their families from the ground up would be astronomical. Does this mean

that there is no realistic hope for change? How can we begin to meet so many desperate

needs with such limited resources? The third annual Binational Health Week

demonstrates that amazing (and measurable) outcomes can be created by mobilizing

existing resources and organizations, creating connections, and then following up in a

systematic way.

The key to Binational Health Week’s effectiveness lies in the synergy of bringing

together so many hundreds of groups and thousands of individuals who are interested in

and committed to improving migrant health. For one week a year, CMHI pulls out all the

stops to try to focus everyone’s attention on the health of migrants and their families.

The months leading up to that week in October are spent making innumerable phone

calls, writing letters, sending emails, teleconferencing, and holding meetings to contact

all the legislators, speakers, consulates, university resources, organizations, clinics,

hometown associations, federations, clubs, promotores/as, individuals and the press.

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In fact, the groundwork for the next BHW begins almost as the last one wraps up. The

general planning guide for the 2003 BHW outlined the following goals, tasks and

timelines:

• At least nine months prior, CMHI renews its efforts to continue building

collaborative relationships with county clinics, community-based organizations

and Mexican consulates by writing letters and preparing information packets on

BHW.

• At least six months prior, CMHI defines the target counties/geographic service

areas and forms a BHW task force headed by a local BHW coordinator, which

will determine funding and other resource needs and identify potential resources.

• At least four months prior, these task forces develop outreach and BHW

promotional and material distribution plans.

• At least two to three months prior, CMHI distributes fact sheets, BHW summary

sheets and other pertinent data to the local task forces to help them develop their

own area-specific fact sheets and calendar of BHW events and activities, which

will be included in the BHW master calendar.

• At least one to two months prior, CMHI and task forces develop a BHW

evaluation plan and data collection tools for local activities and events, establish

deadlines, and compile preliminary reports and estimates. The evaluation process

includes questionnaires to be completed by each task force, summarizing the

binational health week activities held in each location, including the type of

service provided, and the number of persons reached. An additional questionnaire

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is completed by each person receiving services to collect data on demographics

and health history.

• As soon as possible after BHW is over, CMHI collects, compiles, and evaluates

the data, writes the final report and shares the results with the press and all who

were involved.

DISCUSSION OF AREAS OF STRATEGIC CONCERN

This diverse resource of volunteer power, however mighty when mobilized, is also an

area of potential weakness for CMHI. The Initiative must depend on the dedication, good

will and follow-through of all these politicians, academics, public and private health

professionals, community groups, press and individuals continuing to make this

commitment of time and energy year after year. CMHI recognizes how important it will

be to keep migrant health issues visible and as a priority if BHW is to continue to be

successful at improving the health of migrant workers and their families.

Furthermore, CMHI must acknowledge, plan for and try to address the many

complexities and potential difficulties inherent in the political and health care

environments in both countries. These include:

• CMHI’s commitment to serving all Mexican-origin population including the

undocumented, which could inhibit efforts here in California.

• An unstable political climate in both California and Mexico, which could become

unfavorable to address health issues affecting Mexican–origin population

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• Two different sets of infrastructure, California’s and Mexico’s, which make

coordinating and planning cumbersome.

• Health care delivery systems and other non-profits in California, which are not

networked or linked, making the process of working with them more time

consuming.

The results of BHW, however, demonstrate clearly that the strategy—always in the

process of being fine-tuned—can and has produced concrete, measurable improvements

to the health of migrants during the three years of BHW’s existence.

DISCUSSION OF RESULTS

The third Binational Health Week (BHW) activities took place from October 12-19,

2003, in 22 California counties and in 8 Mexican states. Each county provided a variety

of health services and health promotion activities unique to its own area and available

resources. Some of the counties held activities focusing on HIV/AIDS to join those

scheduled nationally to observe National Latino AIDS Awareness Day (October 15).

Fresno, Los Angeles, Orange, San Mateo, Alameda, Monterey, and San Francisco

counties hosted guest promotoras/es (community outreach workers) from Mexico. Over

the course of the week an estimated 70,440 people received 119,242 health-related

interventions, such as screening for HIV, diabetes, and breast cancer; tests for blood

pressure and cholesterol levels; eye and dental exams; educational workshops; and health

insurance enrollment information.

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Local coordinators provided leadership in the organization and promotion of BHW

activities with the guidance and technical assistance of CMHI staff. Local support was

made possible through the joint efforts of at least 1,260 volunteers and 334 agencies,

including representatives from local and state health departments, community-based

organizations and clinics, college and university campuses, local government,

foundations, and Mexican Consulate representatives.

At least 1,200,000 pieces of printed culturally and linguistically appropriate material

were distributed. (Each of the past three BHW campaigns has had a unifying image that

was printed on posters, cards, flyers, brochures, agendas, etc. to link these materials

together. An example of the 2003 image is below.) In 2003 materials for the general

public included: BHW posters; guides to health maintenance organizations; and

educational leaflets on pediatric oral health, STDs, domestic violence, nutrition, family

planning, diabetes, and cancer — many of them donated by Mexican government.

Specialized materials that were distributed included bilingual dictionaries of health-

related terms, requests for research proposals, and training manuals for promotoras/es.

There were four venues that displayed the BHW mural, which includes health promotion

messages, Mexican icons, and the BHW slogan: “Aunque estés lejos, no estás solo,”

(“Although you are far, you are not alone,”). Thanks to the California HealthCare

Foundation, 1,500,000 bilingual guides to insurance and public benefits programs were

distributed as a supplement to the newspaper La Opinion. The guide describes health

insurance programs for the low-income population in California.

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A Binational Public Policy Forum was held at UCLA on October 16-17. It was a major

political event, with the participation of approximately 285 people, including a delegation

of 70 Mexican representatives and public health officials as well as distinguished guests

from both countries. The forum was intended to elevate migrant/immigrant health issues

as a policy priority in the U.S. and Mexico, and to develop bilateral working

recommendations. Expert presenters included representatives from the University of

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California Office of the President, UC Santa Cruz, UCLA, the University-wide AIDS

Research Program, California State University at Fresno, the United States-Mexico

Border Health Commission, the California Public Policy Institute, the California Policy

Research Center, the California Department of Health Services, the United States

Department of Health and Human Services, the California Department of Managed Care,

Stanford Medical School, Texas A & M University, The California Endowment, the

California HealthCare Foundation, the United Farmworkers of America, the California

Institute for Rural Studies, the California State Legislature, and the California Office of

the Governor. From Mexico, there was representation from the Mexican Consulates in

California, the Ministry of Health, state secretaries of health from 7 of the Mexican states

with high international migration (Baja California, Guanajuato, Jalisco, Michoacán,

Morelos, Oaxaca and Puebla) , el Poder Legislativo, el Consejo Nacional de Población,

Instituto para los Mexicanos en el Exterior, Instituto Mexicano del Seguro Social,

Universidad Autónoma de México, Programa de Jornaleros Agrícolas de México,El

Colegio de la Frontera Norte, and Centro Nacional para la Prevención y Control del

SIDA.

The BHW media campaign comprised 53 print articles in 21 newspapers in both

countries. There were also 76 radio programs which aired 10 public service

announcements produced by Radio UNAM (Universidad Nacional Autónoma de México)

and CMHI for Spanish broadcast stations. Additionally, CMHI sent press packets that

included health statistics on the Mexican-origin population to media statewide. Two of

the main TV Spanish-channel, FOX en Español and Televisa, aired 87 hits advertising

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BHW events. Approximately 80,000 people watched daily TV news with BHW

commercials. Four press conferences were held throughout participating California

counties. Thirteen information telephone lines and toll-free numbers were set up to

inform the public about BHW events and services. Also, Mexico provided radio, print,

and TV media coverage. CMHI also created a documentary on Binational Health Week

as a visual testimony of the planning and coordination of BHW and highlights some of

the binational activities implemented during BHW.

Growth of Binational Health Week in California 2001 − 2003

Year # of

Counties

# of

Health

Events

Estimated

# of

People Reached

Estimated

# of

Participating

Agencies

Estimated

# of

Health

Interventions

2001 7 98 18,720 115 37,444

2002 12 167 21,710 280 51,000

2003 22 224 70,440 334 119,242

The growth of Binational Health Week since its inception in 2001 is best illustrated in the

table above. The number of counties in which BHW promotional and educational

materials was distributed, and health activities held, has steadily increased, from 7 in

2001, to 12 in 2002, and to 22 in 2003. The estimate for numbers of interventions was

conservatively estimated by defining an intervention either as educational or as the

provision of a health service, including health screening services.

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CONCLUSIONS

Given the health disparities that characterize vulnerable and low-income populations,

BHW plays an important role in creating political dialogue among state, local, and

federal programs that is intended to improve the quality of life of Mexican-origin

communities. Community-mobilizing efforts such as BHW, and public policy that is

informed by health data that are collected bilaterally, should maintain the issue of migrant

health as a priority in research, program planning, and resource allocation.

As realists, CMHI knows that in one week they cannot change the inadequacies and gaps

within the public and private health care systems that are supposed to address the health

problems of the migrant population. However, as pragmatists relying completely on a

huge mobilization of political leaders, organizations and volunteers, they know they

cannot expect or sustain more than a short period of dedicated time and resource

commitment from these groups and individuals. Even though, many of these

organizations work yearly round with underserved populations.

CMHI short-term strategy is to create an intensive, week-long political and educational

“fiesta” to shift the social and political focus to migrant health care issues, creating a

foundation for policy and community work throughout the year. Their long-term strategy

is to bring together the people who are working on migrant and/or health issues in both

California and Mexico, give them an opportunity to meet and learn from one another,

make connections, and then be able to use one another as resources and for collaborative

projects in the future.

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People have always used social networks to find food, homes, jobs, information, etc. The

question is how to discover and develop these networks to create positive social change

or, as network theorists would say, how to “knit the net.” Krebs and Holley describe how

acting locally can become acting globally:

Transformation that leads to healthy communities is the result of many (often

small) collaboration among network nodes. Complexity scientists describe this

phenomenon—where local interactions lead to global patterns—as emergence.

We can guide emergence by understanding, and catalyzing connections. For

example, knowing where the connections are, and are not, allows a community

development organization to influence local interactions (Krebs and Holley,

2002).

Using this very un-hierarchical model, CMHI is seeking to transform the health care

system on a global level by making thousands of small key connections within and

between the local communities, organizations, universities, states and federal

governments involved with the migrant population. While this allows CMHI to

capitalize on existing resources and take advantage of the innovations possible among

such a diverse group of networks, it also requires that CMHI relinquish any claims to

ownership or control. Now in its fourth year, the concept of BHW no longer belongs to

CMHI. It belongs to the community. CMHI continues to provide basic guidelines

facilitate meetings and provide support, but BHW is now is an organism of its own with

its own binational health network. Who knows how it will grow.

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CONAPO, Migracion Mexico-Estados Unidos Presente y Futuro, 2000. (www.conapo.gob.mx) Davis, Shelley. Farmworker Justice Fund, Inc. Testimony of the Farmworker Justice Fund, Inc. on the Proposed Ergonomic Standard – May 2000. Gabbard, Susan. Aquirre International, personal communication. Harris, MI., Flegal, K.M., Cowie, CC., Eberhardt, MS., Goldstein, DE., Little, R.R., Wiedmeyer, HM., and Byrd-Holt, DD. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults: The Tirad National Health and Nutrition Examination Survey, NHANES), 1988-1994. Diabetes Care, 21:518-254. Krebs, Valdis and Holley, June. “Building Sustainable Communities through Network Building,” 2002. Labor Occupational Health Program, University of California at Berkeley. The Working Immigrant Safety and Health Coalition (WISH), 2002. website: http://ist-socrates.berkeley.edu/~lohp/projects.htm. Martin, Monica in Excelsior, Mexico DF, 1996.

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